October is Breast Cancer Awareness Month. In light of increased mammograms during this month, it is important to know and understand how to code these services.
Centers of Medicare and Medicaid (CMS) now recognizes the CPT mammogram codes, since the G codes CMS previously used in the past were deleted January 1, 2018. The deleted G codes were: G0202, G0204, and G0206. This change makes it easier for coders to accurately report mammogram services since the way to code the services is universal.
+77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
Also report G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066), when appropriate.
Often coders feel that it is necessary to add modifier 50 Bilateral procedure, LT Left side, or RT Right side thinking that the modifier helps define the service performed. Yet, no modifier is required with mammography codes because the codes represent unilateral and bilateral services.
Report mammography services using the appropriate CPT code(s) and G0279, when ordered on the date of service. Be sure the service ordered and performed matches the description of the code.
There are some changes for 2020 ICD-10-CM codes that relate to diagnostic mammograms that went into effect October 1, 2019 including:
N63.15 Unspecified lump in the right breast, overlapping quadrants
N63.25 Unspecified lump in the left breast, overlapping quadrants
Be sure to review CMS’ National Coverage Determination (NCD) for Mammograms prior to coding, even though these codes apply to diagnostic mammograms. CMS has made multiple changes to NCD, so it is important to monitor CMS publications for NCD changes to be able to access the latest version with any coding updates.